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Septic Tank Pumping/Maintenance <br />nn11r <br />Z Z LULJ <br />Owner Information <br />r p: Phone: Ci:� �.:���Z i '11 1 <br />Owner:-,�,,� _ Email: <br />Property Address: Owner's Address (if different) <br />Tank Information <br />Reason for Pumping: ❑ Complinace Inspection O Holding Tank Maintenance <br />Method of Access: Manholes O Inspection Pipe (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Condition of Tanks: <br />Filter Cleaned Yes Baffles good: s Alarm working: Yes <br />No zoo* <br />No <br />N/A ��' A <br />'tank Leakage nhserN ed: Above operating depth Ye (repairs recommended) � <br />Below operting depth Yes o (failing to protect groundwater) <br />(...,ions Removed: <br />�91 1 r" :.) #2 =,W #3 #4 Pump tank Total 6W <br />Disposal Method: Municipal: Q Location: Watertown Wastewater Facil <br />Land Applied: ❑ Location: <br />Safety Concerns: <br />mended Repairs: <br />(Comments: `AN.—( -11-�.AA 11 rll. , <br />1 hereby certify that I have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No determination or guarantee of future syste ante has been nor can be made. <br />Chip's Septic Service, LLC & SSTS <br />_S"rtzer's Sewer Services License <br />j2 Babcock Avenue Maintaner Signature #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipseptic&Lnail.com <br />revised 312025 <br />